While obviously I’m not going to make a difference here, I figure I’m like a lot of voters around the median on this issue. I also think that it’s important for Democrats to understand what got them in trouble in the ACA fight and avoid those same mistakes in the single payer fight to come. Which BTW, they are insane for even thinking about doing again, but whatever.
From a PR standpoint, when opponents bring up the very real tradeoffs involved in single payer, do not attribute it to a fearmongering campaign. yes, there will be some batshit insane claims made, and those should be disposed of. But the real critiques that have been well understood from decades of practice in other countries should be rebutted in a fair manner. There’s no surer way to get people like me riled up than to dismiss legitimate concerns. I want to know that you are aware of things like cancer survival rates and wait times and lack of access to GPs, and have either a plan or a justification. The debate must be a healthy one, with benefits and drawbacks weighed fairly in the public discussion.
On a more substantive note, single payer must be paid for with a dedicated funding stream on a broad base. A payroll tax, a sales tax, a VAT. Sanders’ 2016 plan had a dozen taxes designed to hide the true cost, and once it was all added up it didn’t even come close to actually paying for single payer. Single payer is going to cost $2 trillion. That is not a figure you play accounting games with or try to tax a minority to achieve. Other countries raise that level of money with social insurance taxes that hit everyone except the poorest. There will be no single payer solely on the backs of wealthy voters. Even if we could do it in this decade, we wouldn’t be able to keep it that way in subsequent decades. Getting people addicted to single payer whne it’s “free” and then making them pay out the nose to keep it is deceeption of the worst order. Fund it right from the beginning.
What is and is not covered must be transparent This is one area where Britain excels over everyone else. NICE analyzes every drug and treatment and decides if it’s worth paying for. I’d go a step further. Medicare for all should be held to a growth rate. New drugs and treatments can only be added if they will not cause Medicare to exceed its targeted growth rates. Our version of NICE can issue two reports: one that budgets Medicare for the year within the target, which means few new drugs and treatments will be approved, and other alternatives that go over budget but do add in some new drugs and treatments, and also raises the social insurance tax. Congress can only vote on these plans. They cannot vote just to raise the deficit.
** No restrictions on private alternatives** This is a free country and if people want to pay into the system AND buy private insurance instead, or pay cash to providers, that should be allowed just like paying your property taxes and sending your kid to private school is allowed. A government that bans competition is afraid of competition.
So to sum up, it must be budget neutral, funded sustainably, honestly sold, completely transparent, and the right to pay for alternatives must be preserved.
If the current last-ditch ACA repeal bill passes, CA, MA, and NY will all go single payer using Fed money, they’ll be allowed to. All that revenue will be taken away from carriers. Do you know what effect that will have on people in the poorer, sicker states, ex-ACA?
I’m not sure that these states would have the money to do it, and there would be political consequences for going single payer at the state level. Depending on what comes out of the legislative wheelhouse, it’s not clear how businesses would react. I think single payer would work much better at the federal level than at the state level.
Single payer can work at the state level just fine. It can only “work” better at the federal level because it’s easier for the feds to hide the costs or just fund it through deficit spending. But that’s something that can’t be allowed to happen.
Single payer is hard. It’s going to mean big taxes, which will be mostly offset by not having to pay insurance premiums. But the choice has to be transparent and clear, and Vermont and California thought it wasn’t going to sell. That’s worrisome, because it means Dems might go for the “hide the cost” approach, which is much easier to pull off at the federal level. You can rest assured that Republicans won’t let them get away with that without paying a big price and I’ll be right with them if that’s how it all goes down.
I think these are fair criticisms and your questions in the OP are reasonable, but ISTM you’re being very easy on the Republicans here. They’re being and have been just as dishonest (far more so, IMO) about health care than the Democrats, but you’ll be “right with them” if the Democrats don’t handle this perfectly.
They’ll be able to use 100% of block grant money from the Feds. Even with a reduced amount of block grant $ as punishment for being blue states, they’ll be able to do it because they’re wealthy, and no shareholders.
Meanwhile, everywhere else, medicaid gets cut, millions get thrown off of plans, the Obamacare protections vaporize.
OK, so what tradeoffs do you contend are the legitimate ones? You mention wait times: Of course single-payer systems have wait times. But so does the bastard system we have now, and the single-payer wait times are shorter. How is that a “legitimate tradeoff”?
You’re right about the Republicans, but I’m not expecting Dems to handle it perfectly. The funding of a $2 trillion program is a HUGE deal and I’ve left open many avenues to fund it. I just expect those avenues to be transparent and sustainable. I won’t join the Republicans in all their attacks, but I’ll back them to the hilt on revenues if Democrats try to fund it through gimmicks. ACA was not exactly the height of transparency in this regard. It raised $100 billion per year primarily through little taxes and assumed savings. Single payer is going to be 20 times larger than that.
You’re doing it exactly right. If I point out wait times, you respond with how the current system has wait times, and then I can respond with data of my own showing that ours aren’t as bad in many ways or happen for different reasons. You could also respond to “tax increase!” with “premiums eliminated!” or critiques based mainly on the failures of the NHS with “We’re not doing it that way” or “we’re learning from their mistakes” or “they underfund their system, we won’t”.
What I don’t want to see a repeat of is seizing on the most outrageous anti-single payer arguments and lumping all criticisms in with those. We’ll definitely see the politicians doing that, that’s just what politicians do, but I’m hoping that the media and discussion boards will be fairer to both sides.
Canada’s “single payer” system is run by the provinces. Single payer generally just means the government pays, but which governments pay varies by country.
Yeah, end of life care is a big issue, and that’s something else that will have to be dealt with transparently. From what I have read, which could be legit or could be scare stories, it’s a lot harder to get a lot of things done when you’re a senior citizen in single payer systems. Britain uses a QALY standard(Quality Adjusted Life Years) when making approval decisions, so again, Britain wins on transparency and that IS a part of their system we should adopt. But other nations don’t seem as willing to let that stuff get out to the public.
I’d also note that you’re going to have to pass single payer over some very vociferous opposition from seniors. Which is why you might want to consider dumping the Medicare idea entirely and give the single payer system a new name and grandfather current or soon to be Medicare recipients.
IT has to be budget neutral because otherwise it won’t be sustainable. Medicare Part D was an extremely irresponsible program.
As for seniors being against it, they’ll be against it because it will probably reduce their access to care. Single payer systems don’t give seniors access to all care. But we have something strange, we have a system ONLY for seniors that denies them nothing that is medically necessary.
Thinking like a Republican(which I’ve been and still tangentially am), I know exactly how I’d approach getting seniors to turn against a single payer program. So the best approach would be to either grandfather Medicare instead of just putting everyone on it, or do what I suggested, start out with it covering everything Medicare does and get cost under control only by limiting new treatments that come out after the program goes into effect.
Republicans are historically sensitive to Mediscare attacks, so their plans all grandfather Medicare as it is. Democrats would be smart to follow suit, or structure the single payer plan so that seniors would see no reduction in access. Best to grandfather, IMO, because if you start seeking cost savings in things like end of life care, you probably want people who are young or middle aged now to assent to it rather than trying to talk current seniors into it.
Interesting, but I think the strategy is the opposite for good reason. The general public understands what Medicare is and generally approves of it. “Expanding Medicare” is a simple concept. An entirely new program is a harder sell, and more vulnerable to attack. Remember “death panels”? It’s harder to make baseless attacks like that catch on when we’re talking about expanding an existing program.
That’s actually a deception though, because the program they are selling isn’t Medicare, it’s Medicaid. I’ll let that pass though, since it doesn’t affect anything substantive about it, plus all sorts of details still have to be worked out. What they call it is of only mild concern to me.
Glenn Kessler points out another often repeated claim that isn’t quite factual: Medicare’s superiority on administrative costs:
This isn’t really a big problem for me, but I do get rankled anyone tells me single payer can be paid for in large part through administrative savings.
I don’t understand this. It can’t be budget-neutral because the money to pay for it has to come from somewhere. That means that taxes must increase to pay for it. Sure, people will no longer have to pay health insurance premiums, but the government’s tax take must increase.
I do expect wait times to increase under single payer, but basically for the reason that there are more people who will actually have access to healthcare. So some peoples wait times increase from one week to two weeks while others decrease to two weeks from infinity. Complaining about the fact that universal coverage will lead to longer wait times is like complaining that after Rosa Parks it was harder to find a seat at the front of the bus.
